Application for International Admission $100 Application Fee. Nonrefundable. Please type or print clearly and fill in all blanks.
LEGAL NAME ______________________________________________________________________________________________________________________________
Last
First
Middle
Preferred
PERMANENT ADDRESS ______________________________________________________________________________________________________________________________
Street
City
providence/territory
postal code
Country
MAILING ADDRESS ______________________________________________________________________________________________________________________________
Street
City
providence/territory
postal code
Country
Country of Birth ___________________________________________________________
Country of citizenship __________________________________________________________
Home PHONE ( ) - ___________________________________________________________
CELL Phone ( ) - __________________________________________________________
E-MAIL ADDRESs _______________________________________________________________________________
DATE OF BIRTH / / ____________________________________________
Month
Day
Year
Responses to the following questions are voluntar y and will be k ept confidential. Failure to provide this information will not affect the status of this application. Please check the appropriate answer. GENDER
Female
Male
MARITAL STATUS
Divorced
Married
Separated
Single
Widowed
select one or more of the following racial categories to describe yourself: American Indian or Alaska Native
Asian
Black or African American
Yes
ETHNICIT Y: Do you consider yourself to be Hispanic/Latino?
No
Native Hawaiian or Pacific Islander
RELIGIOUS AFFILIATION ______________________________________________________
HIGH SCHOOL __________________________________________________________________________________
Name
City
White
State
Graduation Date / ________________________________________ Month
Year
List all previously attended colleges or universities, star ting with the most recent. Include attendance at D elta State.
College Name
City and State
Dates of Attendance
Degree Earned
1 ______________________________________________________________________________________________________________________________ 2 ______________________________________________________________________________________________________________________________ 3 ______________________________________________________________________________________________________________________________
WHEN DO YOU PLAN TO ENTER DELTA STATE UNIVERSIT Y? Fall 20________
Spring 20________
Degree Seeking?
Yes
No
WHAT UNDERGRADUATE CLASSIFICATION DO YOU EXPECT TO HAVE WHEN YOU ENROLL? (Semester Hours Passed–SHP) Freshman (0–29 SHP)
Sophomore (30–59 SHP)
Junior (60–89 SHP)
Signature Required On Back
Senior (90–OVER SHP)
check only one space beside your intended major BACHELOR OF ARTS (BA) ___ Art (BA-ART 1000) ___ Art Education (BA-ART-EDU1001) ___ English (BA-ENG1400) ___ Philosophy Concentration(BA-ENG-PHI 1870) ___ CreativeWriting(BA-ENG-CW1403) ___ EnglishConcentration(BA-ENG-ENG1400) ___ Foreign Languages (BA-FL 1420) ___ French(BA-FL-FR1430) ___ Philosophy (BA-FL-PH1872) ___ Spanish(BA-FL-SP1410) ___ History (BA-HIS 1300) ___ Journalism(BA-JOU1480) ___ Music(BA-MUS 1600) ___ Political Science (BA-PSC1800) ___ Psychology (BA-PSY5100) ___ Communication Studies &Theatre Arts (BA-CSTA1473) ___ CommunicationStudies (BA-CSTA-CS1401) ___ TheatreArts (BA-CSTA-TA1471)
___ Keyboard/Instrumental (BM-MUS-KEY1631) ___ Vocal Performance(BM-MUS-VOC1632)
___ AudioEngineeringTechnology (BSMIS-AET 1652) ___ MusicIndustry Entrepreneurship(BSMIS-MIE 1654)
BACHELOR OF MUSIC EDUCATION (BMEd)
BACHELOR OF SCIENCE IN EDUCATION (BSEd)
___ MusicEducation (BME-MUS 2620) ___ Instrumental Music(BME-MUS-IME2624) ___ Choral/General Music(BME-MUS-CGM2626)
BACHELOR OF SCIENCE (BS)
___ Aviation Management (BCA-AM3300) ___ Flight Operations (BCA-FO3310)
___ AthleticTraining(BS-AT 5350) ___ Biology (BS-BIO1200) ___ General Biology Concentration(BS-BIO-GEN1201) ___ Premedical ScienceConcentration(BS-BIO-MED1202) ___ Biology EducationConcentration(BS-BIO-EDU1205) ___ Chemistry (BS-CHE 1700) ___ General Chemistry Concentration(BS-CHE-GEN1701) ___ ACSCertifiedChemistry (BS-CHE-ACS1702) ___ Premedical ScienceConcentration(BS-CHE-MED1703) ___ Chemistry/General ScienceEduc. Conc. (BS-CHE-EDU1704) ___ Environmental Science (BS-ENV 1210) ___ General Environmental ScienceConc. (BS-ENV-GEN1212) ___ Geospatial InformationTechnology (BS-ENV-GIT8075) ___ WildlifeManagement Conc. (BS-ENV-WM1214) ___ Family & Consumer Sciences (BS-FCS 5405) ___ ChildDevelopment Concentration(BS-FCS-CD5401) ___ Nutrition/Dietetics Concentration(BS-FCS-ND5404) ___ FashionMerchandisingConcentration(BS-FCS-FM5410) ___ Health, PE andRecreation (BS-HPER 5300) ___ HealthandPhysical Education(BS-HPER-HPE5302) ___ RecreationConcentration(BS-HPER-REC5303) ___ Sports InformationConcentration(BS-HPER-SI 5304) ___ Sports Management Concentration(BS-HPER-SM5305) ___ ExerciseScienceConcentration(BS-HPER-ES5306) ___ Mathematics (BS-MAT 1500) ___ Social Science (BS-SSC1820) ___ Geography Concentration(BS-SSC-GEO1821) ___ Sociology Concentration(BS-SSC-SOC1826) ___ AppliedDevelopment Studies Conc. (BS-SSC-ADS1827) ___ Social ScienceConcentration(BS-SSC-SSC1828) ___ Speech andHearingSciences (BS-SHS 1100)
BACHELOR OF FINE ARTS (BFA)
BACHELOR OF SCIENCE IN SOCIAL JUSTICE AND CRIMINOLOGY (BSJC)
BACHELOR OF BUSINESS ADMINISTRATION (BBA) ___ Accounting(BBA-ACC3100) ___ Computer Information Systems (BBA-CIS 3400) ___ Finance (BBA-FIN3500) ___ General Business Administration (BBA-GEN3520) ___ Entrepreneurship(BBA-GEN-E3521) ___ General Business Administration(BBA-GEN-GEN3520) ___ Hospitality Services Management (BBA-HSM3700) ___ Insurance andReal Estate (BBA-IRR 3510) ___ Real Estate(BBA-IRR-RE3511) ___ Financial Planning(BBA-IRR-FP3512) ___ Management (BBA-MGT 3600) ___ International Business Development (BBA-MGT-IBD3601) ___ Management (BBA-MGT-MGT3600) ___ Marketing(BBA-MKT 3610)
BACHELOR OF COMMERCIAL AVIATION (BCA)
___ Art (BFA-ART 1000) ___ Crafts Emphasis (BFA-ART-CR1002) ___ GraphicDesignEmphasis (BFA-ART-GD1003) ___ PaintingEmphasis (BFA-ART-PA1005) ___ Photography Emphasis (BFA-ART-PH1007) ___ SculptureEmphasis (BFA-ART-SC1006)
___ Social Justice & Criminology (Bsjc 1815)
BACHELOR OF MUSIC (BM)
BACHELOR OF SCIENCE IN MUSIC INDUSTRY STUDIES (BSMIS)
___ Music(BM-MUS 1600)
___ Elementary Education (BSE-ELE 5210) ___ English Education (BSE-ENG2400) ___ Health, PE andRecreation (BSE-HPER 5300) ___ Mathematics Education (BSE-MAT 2500) ___ Social Science Education (BSE-SSC2820)
BACHELOR OF SCIENCE IN NURSING (BSN) ___ Pre-Nursing(BSN-PRE-NUR 0005) ___ Pre-RN/BSN(BSN-PRE-RNBS 0006)
BACHELOR OF SCIENCE IN SOCIAL WORK (BSW) ___ Social Work (BSW1830)
PRE-PROFFESSIONAL CURRICULA (BS) ___ Biology (BS-BIO1200) ___ Clinical Laboratory Sciences (BS-BIO-CLS0212) ___ Cytotechnology (BS-BIO-CYT0214) ___ Dental Hygiene(BS-BIO-DH0240) ___ HealthInformation& Informatics Mgmt (BS-BIO-HIM0255) ___ Medical Records Administration(BS-BIO-MRA0250) ___ Occupational Therapy (BS-BIO-OT0270) ___ Physical Therapy (BS-BIO-PT0220) ___ Pre-Dental (BS-BIO-DEN0740) ___ Pre-Optometry (BS-BIO-OPT0730) ___ Pre-Pharmacy (BS-BIO-PHA0710) ___ Pre-Veterinary Medicine(BS-BIO-VET0230) ___ RadiologicSciences (BS-BIO-RAD0216) ___ RespiratoryTherapy (BS-BIO-RES0260) ___ Chemistry (BS-CHE 1700) ___ Pre-Dental (BS-CHE-DEN0740) ___ Pre-Pharmacy (BS-CHE-PHA0710) ___ Pre-Veterinary Medicine(BS-CHE-VET0230) ___ Occupational Therapy (BS-CHE-OT0270) ___ Pre-Optometry (BS-CHE-OPT0730) ___ Physical Therapy (BS-CHE-PT0220) ___ Mathematics (BS-MAT 1200) ___ Pre-Engineering(BS-MAT-EGN0510)
BACHELOR OF SCIENCE IN INTERDISCIPLINARY STUDIES (BSIS) ___ Interdisciplinary Studies (BSIS 8000) ___ Geospatial InformationTechnology (8075)
___ MusicIndustry Studies (BSMIS 1650)
I hereby make application to Delta State University and agree to abide by the regulations of the University and to accept responsibility for payment of all charges incurred while I am a student. I furthermore declare that the information on this application is complete and accurate.
__________________________________________________________________________________ APPLICANT’S SIGNATURE
________________________________________ DATE
SEND ADMISSION DOCUMENTS AND $100 APPLICATION FEE TO: Office of Admissions | Kent Wyatt Hall Room 117 | Cleveland MS 38733 | Phone: 662.846.4020 | Email: admissions@deltastate.edu Delta State University is committed to a policy of equal employment and educational opportunity. Delta State University does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or veteran status. This policy extends to all programs and activities supported by the University.